Unions, At-will Employment, and Safe Staffing

Many nurses, solely concerned with their clinical practice, are not knowledgable about working conditions and labor.

Tiffany asks “I’m a new grad and recently landed my dream job in L & D in a well known hospital in the northern part of my state. I thought things were going well until I was assigned to a new preceptor. She didn’t like me and within a few weeks she got me terminated. I never received a warning of any kind. Can they really do that?”

At-Will Employees

Employees are often unaware that employers do not need a reason to fire you. At-will laws protect the employer, not the employee.

Unions at-will and safe staffing

Like most nurses, Tiffany is an at-will employee. Under an at-will employment arrangement, employees can be terminated with or without cause and with or without notice.  Most employees work under an at-will arrangement, whether they know it or not.

The legal exception to at-will employment is when the employee has a contractual agreement with the employer. Usually this takes the form of a union contract.

What About Progressive Discipline?

Mistakenly, many nurses believe that the employer has to give them another chance, or at least give them written warning when there is a perceived performance problem. It is important to give employees constructive feedback in a timely manner but it doesn’t always happen. Read How to Precept a Know-it-All. What is right and fair is not always what’s legal.

Employers are expected to follow their own policies. Policies vary according from organization to organization. Some organizations have polices stating they can terminate employees without progressive discipline or notice of any kind within the first three months of employment, or for the duration of orientation. Human resource policies  may or may not include progressive discipline. Here’s what to do if you receive a disciplinary warning at work.

While employers  can be held liable for violating their own policies, policies are not law.

What then is wrongful termination?

Anytime an employer violates federal, state, or local anti-discrimination laws they can be charged with and found guilty of wrongful termination. Federal law protects employees from being discriminated against or terminated for race, color, pregnancy, age, disability, national origin, or religion.

In addition, employers cannot retaliate against employees for reporting their employer to a governmental body for violation of workplace safety laws.  If an employee reports an unsafe work condition to a government agency, the employee cannot be terminated for whistle-blowing.

Likewise, if an employee is terminated for taking time off under a law which gives him or her a legal right to have that time off, such as time off for voting or military service, he or she may also have a valid wrongful discharge cause of action.


Right-to-work means you do not have to join a union when you are hired. It’s your choice. This means that if you are hired by a hospital where the nurses are unionized, you cannot be forced to join the union, go out on strike, or pay union dues.

About half of the states are right-to-work states. Check here to see if your state is a right-to-work state or not.

In non right-to-work states, you do not have a choice, and must join the union if you are hired by a unionized hospital.

Critics of right-to-work argue that all employees should have to join the union and pay dues, as a union contract benefits all employees, union member or not. Unions, such as the AFL-CIO, are anti right-to-work laws and lobby against them.

Unions and Nurse:Patient Ratios

Except for California, staffing ratios are set by  hospitals and not by law.

The California Nurses Union (CNA)/National Nurses United (NNU) was instrumental in passing legislature to enact the country’s first and only staffing patient ratios. National Nurses United (NNU) is the largest nurses union in the country.

In addition to securing nurse patient ratios, NNU  won changes in CA state regulations to assure that every patient be assessed by a registered nurse and limited unsafe assignment of RNs to work in hospital areas for which they do not have clinical expertise.

In CA the nurse:patient ratios are:

ICU 1:2

Telemetry 1: 4

MedSurg 1:5

Step Down 1:3

Emergency Room 1:4 (trauma, 1:1, ICU holds 1:2)

Currently the grassroots movement and large Facebook group, Show Me Your Stethoscope, is planning their second annual descent on Washington DC in May 2017 to advocate for safe staffing legislation. Legislation has been also filed and is pending in several states to implement safe staffing by organized nursing groups, such as New York Association for Nurses.

The American Nurses Association  (ANA)calls for safe staffing ratios to take into consideration patient acuity, and nurse expertise. ANA promotes staffing committees comprised of 55% nurses to establish safe staffing guidelines.

It’s important for nurses to understand the forces at play that dictate their work environment, their patient assignments, their patients, and even their jobs. Educate yourself so that you can have a voice in the national discussion around working conditions and patient safety.


Until next time,

Nurse Beth

Come visit me at Ask Nurse Beth career column at allnurses.com for all kinds of  entertaining and informative career questions and answers, and to submit your own question :) Or visit me at nursecode.com and StaffGarden where I also blog. Buzzzzzz…I’m a busy little bee !

About Beth Hawkes

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Nurse Beth (Beth Hawkes, MSN, RN-BC), is a nursing career specialist and blogs at nursecode.com. She's also the author of Your Last Nursing Class: How to Land Your First Nursing Job. If you have ever submitted a resume or interviewed and never heard back, this book is for you. You will learn why never to say “I’m a perfectionist” when asked “What’s your greatest weakness?” You will be given insider tips and discover what nurse managers are really looking for in a candidate. Filled with real life examples and testimonials, “Your Last Nursing Class: How to Land Your First Nursing Job” truly is the ultimate guide to composing winning cover letters, essays, resumes-and landing a nursing job. Available at Amazon.